| NPI | 1881679454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 709) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT001484) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2018-03-17 |