| NPI | 1285825398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 0238) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: OK 22098) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2007-08-05 |