| NPI | 1437391208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2005039193) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 203) |
| 101YP2500X Counselor, Professional (Licence: OK 2966) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2015-03-12 |