| NPI | 1457572257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 3610) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 536) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2018-03-17 |