| NPI | 1750612545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OK 20698) |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2010-01-19 |