| NPI | 1053658534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OK 2874) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 798) |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2014-09-19 |