| NPI | 1619109352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 5320) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 902) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2021-10-11 |