| NPI | 1578894168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 596) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 451) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2010-01-20 |