Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003099672 |
---|---|
Provider Name | Mr. Marco M Smith |
First Address | Norman, OK 73071-5305 |
Second Address | Norman, OK 73071-5305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2007 |
Last Update Date | 06/12/2007 |