| NPI | 1346621281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 1354) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 7221) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2019-11-08 |