| NPI | 1821101551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 96) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: OK 00) |
| 101YP2500X Counselor, Professional (Licence: OK 1424) | |
| 106H00000X Marriage & Family Therapist (Licence: OK 714) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |