| NPI | 1043340748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 102155) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 166) |
| 101YP2500X Counselor, Professional (Licence: OK 3491) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2019-01-08 |