| NPI | 1235267337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK LADC 278) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK LMFT 761) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-08 |