| NPI | 1609331230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: OK 1350) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 5439) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2024-12-02 |