| NPI | 1073955613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 1404) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 5570) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2022-03-24 |