| NPI | 1275069577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 113818) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW84456) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2023-07-05 |