| NPI | 1528557378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111073) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2026-09-01 |