| NPI | 1720014814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OK 212) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK 525) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-07-08 |