| NPI | 1861505034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 1603) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 21) |
| 101YM0800X Counselor, Mental Health (Licence: OK 1603) | |
| 101YP2500X Counselor, Professional (Licence: OK 1603) | |
| 106H00000X Marriage & Family Therapist (Licence: OK 724) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |