| NPI | 1104354687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 8317) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-12-06 |