| NPI | 1124513098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WV DP00945530) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2023-07-25 |