| NPI | 1073555405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 412) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 311) |
| 106H00000X Marriage & Family Therapist (Licence: OK 412) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2015-03-10 |