| NPI | 1528267119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 3256) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 3256) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 522) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2018-04-03 |