| NPI | 1497587166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 320819) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OK 135552) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2026-07-13 |