| NPI | 1306159686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW100900) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW66765) |
| 1041C0700X Social Worker Clinical (Licence: CA ASW66765) | |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2021-04-21 |