NPI | 1215147525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 3076) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 636) |
Enumeration Date | 2007-05-23 |
Last Update Date | 2008-11-13 |