| NPI | 1477763811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 143) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 3195) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2011-10-03 |