| NPI | 1194347443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61645372) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 104192) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-09 |
| Last Update Date | 2025-01-18 |