| NPI | 1184830119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LPC 118) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK LMFT 053) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2009-03-19 |