| NPI | 1194939116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 527) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 1062) |
| 101YP2500X Counselor Professional (Licence: OK 1756) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |