| NPI | 1245629443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YS0200X Counselor, School | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical (Licence: CA 116855) | |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2023-09-06 |