| NPI | 1649595976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 56996) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2010-03-30 |