| NPI | 1578881124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OK 1329) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 1150) |
| 101YP2500X Counselor, Professional (Licence: OK 5228) | |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2019-08-01 |