| NPI | 1306380316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 113742) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 113742) |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2025-10-29 |