| NPI | 1184816480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 4485) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK 1017) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2024-02-05 |