| NPI | 1184235038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 129127) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW103054) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW103054) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA f3678545) | |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2026-05-06 |