| NPI | 1750415857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 796) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 2848) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2019-04-18 |