| NPI | 1053893180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 97694) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW97694) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2025-12-02 |