| NPI | 1386920585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK LCSW 296) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK LMFT 328) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2022-01-10 |