| NPI | 1023024247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 321) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: OK 68) |
| 103TF0200X Psychologist, Forensic (Licence: OK 321) | |
| 106H00000X Marriage & Family Therapist (Licence: OK LMFT) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-09-14 |