| NPI | 1487776431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 3230) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK 1019) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2014-09-10 |