| NPI | 1487141107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 112262) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2023-02-03 |