| NPI | 1336243427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 579) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 1087) |
| 106H00000X Marriage & Family Therapist (Licence: OK 317) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2007-07-08 |