| NPI | 1396173654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 21413) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2025-06-04 |