| NPI | 1295251585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111385) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 90168) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2023-01-18 |