| NPI | 1295168664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 74293) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW74293) | |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2017-01-12 |