| NPI | 1376029876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 133296) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 109891) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2025-08-26 |