| NPI | 1265928584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW113179) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW91944) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2023-01-23 |