| NPI | 1043742091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 117987) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 117987) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-01-08 |