| NPI | 1528557378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111073) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2022-10-24 |