| NPI | 1396452330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK LPCCANDIDATE12519) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OK 317198) |
| 175T00000X Peer Specialist (Licence: OK 134121) | |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2024-12-02 |