| NPI | 1639358476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 4625) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I-7800) |
| 1041S0200X Social Worker, School (Licence: OH OH1-55-0985) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2013-09-05 |