| NPI | 1285828541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 62654) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1041C0700X Social Worker, Clinical (Licence: MA 216465) | |
| 101YM0800X Counselor, Mental Health | |
| 101YM0800X Counselor, Mental Health (Licence: CA 29480) | |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2015-02-18 |