| NPI | 1639322449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 960033694) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 844) |
| 101Y00000X Counselor (Licence: OK 1238) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 681) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 002740) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 12700) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 2397) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2008-10-24 |