| NPI | 1609933126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 699) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 1028) |
| 101YM0800X Counselor, Mental Health (Licence: OK 1028) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2011-07-13 |