| NPI | 1477067148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101938) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA ASW80336) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2021-06-16 |