| NPI | 1205212180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 112178) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA F1322801) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2025-09-03 |