| NPI | 1770322844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 20907) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 20907-P) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2026-07-15 |