| NPI | 1124402821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 87306) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 71869) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2019-02-20 |