| NPI | 1790992162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 11498) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 2537) |
| 106H00000X Marriage & Family Therapist (Licence: LA 450) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-06-29 |