| NPI | 1316427750 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 121991) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2024-04-18 |