| NPI | 1124729306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00945310) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV DP00945310) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2024-05-06 |