| NPI | 1427451673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100120) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 85944) |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2021-03-01 |