| NPI | 1982964920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 418) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OK 239) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2016-08-27 |