| NPI | 1689695777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 1987) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 462) |
| 1041C0700X Social Worker, Clinical (Licence: TX 30826) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2022-08-03 |