| NPI | 1245717008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW134116) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2025-09-29 |