| NPI | 1689601759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 751) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK 407) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2009-08-06 |