| NPI | 1366786964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker School (Licence: NV LCSW9786-C) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW79079) |
| 1041C0700X Social Worker Clinical (Licence: CA LCSW96233) | |
| 1041C0700X Social Worker Clinical (Licence: NV 9786-C) | |
| 225400000X Rehabilitation Practitioner | |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2022-04-01 |