| NPI | 1104241470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 100177) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW76002) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2021-03-03 |