| NPI | 1184761553 |
|---|---|
| Former Name | WILLIE L HASKINS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: OK LPC 2868) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-07-09 |