| NPI | 1386801942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 3992) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 606) |
| 101YM0800X Counselor, Mental Health (Licence: OK 3992) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2024-01-04 |