| NPI | 1225682990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW134139) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2026-02-24 |