| 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 |