| NPI | 1356497812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 155) |
| 101YP2500X Counselor, Professional (Licence: OK 3682) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-11-12 |