| NPI | 1326480252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 4751) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AR 26739-C) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2025-10-10 |