| NPI | 1073050308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 682) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK 268) |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2022-01-28 |