| NPI | 1982952859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OK 3172) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 211) |
| 101YM0800X Counselor Mental Health (Licence: OK 3172) | |
| Enumeration Date | 2012-08-26 |
| Last Update Date | 2013-05-16 |