| NPI | 1114987534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 594) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 2899) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2017-01-31 |