| NPI | 1285644674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OK 2130) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 547) |
| 101YP2500X Counselor Professional (Licence: OK 2008) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2011-11-14 |