| NPI | 1003405135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WV DP00945318) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH I.2105801) |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2025-09-12 |