| NPI | 1013119809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 04600) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 10030) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2024-10-16 |