| NPI | 1023146073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 64824) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 44150) |
| 101YM0800X Counselor, Mental Health (Licence: OK 8017) | |
| 101YP2500X Counselor, Professional (Licence: OK 1138) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2009-01-16 |