| NPI | 1386055630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 117901) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 106S00000X Behavior Technician | |
| 225400000X Rehabilitation Practitioner | |
| 101YM0800X Counselor, Mental Health (Licence: CA 117901) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2024-01-22 |