| NPI | 1437704061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114960) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 95858) |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2023-07-03 |