| NPI | 1326396094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7664) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 81018) |
| 1041C0700X Social Worker, Clinical | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2023-05-03 |