| NPI | 1447468723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 506) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OK 3787) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |