| NPI | 1114088895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 758) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 1673) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2011-05-10 |