| NPI | 1124383542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 7177) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator (Licence: OK 12750) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2021-06-22 |