| NPI | 1295383560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW96365) | |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW96365) | |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2026-09-02 |