| NPI | 1518411685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 104584) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW84821) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2022-09-23 |