| NPI | 1962994301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 8155) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 6451-P) |
| 1041C0700X Social Worker, Clinical (Licence: KY 256598) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2023-03-30 |