| NPI | 1467128371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 1420) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 352) |
| 101YM0800X Counselor, Mental Health (Licence: OK 1420) | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2021-08-19 |