| NPI | 1851477194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 2620) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 141110-3501) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2007-07-08 |