| NPI | 1700829736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OK 3458) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 11287) |
| 106H00000X Marriage & Family Therapist (Licence: TX 4071) | |
| 101Y00000X Counselor (Licence: NM 54628) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-09 |