NPI | 1053835777 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101746) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
101YM0800X Counselor, Mental Health (Licence: CA 94944) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-08-03 |
Last Update Date | 2021-06-03 |