| NPI | 1073859542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 96644) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2020-11-12 |