Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | OK |
NPI | 1013288984 |
---|---|
Provider Name | Mr. John E Moore II |
First Address | Oklahoma City, OK 73104-4209 |
Second Address | Oklahoma City, OK 73104-4209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 12/09/2012 |