| NPI | 1003469834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 132555) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA Y8424643) |
| Enumeration Date | 2019-07-21 |
| Last Update Date | 2025-08-04 |