| NPI | 1740071786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WV BP00943232) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV BP00943230) |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-05-16 |