| NPI | 1841210408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 91) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OK 2582) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-09 |