| NPI | 1598778920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 577) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK 717) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2011-09-14 |