| NPI | 1790798130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK OK LMFT 734) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OK OK LPC 1266) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2011-09-14 |