| NPI | 1942053210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 320543) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2025-06-17 |