| NPI | 1205485125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 113391) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist | |
| 175T00000X Peer Specialist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2025-01-22 |