| NPI | 1114294402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114410) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 78064) |
| 104100000X Social Worker (Licence: CA 78064) | |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2023-03-30 |