| NPI | 1821101551 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 714) | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 96) | 
| 101YP1600X Counselor, Pastoral (Licence: OK 00) | |
| 101YP2500X Counselor, Professional (Licence: OK 1424) | |
| Enumeration Date | 2006-08-16 | 
| Last Update Date | 2025-09-11 |