| NPI | 1235551425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW85066) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW66456) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2021-03-24 |