| NPI | 1396110961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 11403) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 115239) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2024-05-23 |