| NPI | 1639576911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 1398) |
| Additional Taxonomies | 305S00000X Point of Service |
| 374K00000X Religious Nonmedical Practitioner | |
| 170300000X Genetic Counselor, MS | |
| 175F00000X Naturopath | |
| 225400000X Rehabilitation Practitioner | |
| 225C00000X Rehabilitation Counselor | |
| 101YM0800X Counselor, Mental Health (Licence: OK 10778) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP1600X Counselor, Pastoral | |
| 104100000X Social Worker | |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2023-05-12 |