| NPI | 1134471063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA ASW 33934) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CT 08800) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2022-01-13 |