| NPI | 1033680699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110768) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 104100000X Social Worker (Licence: CA 91721) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2024-09-18 |