| NPI | 1235469800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 1041) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 1158) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2012-10-18 |