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 |