| NPI | 1235688524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW109772) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW109772) |
| 106H00000X Marriage & Family Therapist (Licence: CA ASW109772) | |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2023-07-05 |