| NPI | 1083716641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 652) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OK 589) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2025-09-11 |