| NPI | 1255923793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW123031) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW123031) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2024-08-08 |