| NPI | 1083125199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA lcsw104861) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA asw83117) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW83117) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2026-04-20 |