| NPI | 1881016772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 992) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 992) |
| 171M00000X Case Manager/Care Coordinator (Licence: OK 992) | |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2019-07-16 |