| NPI | 1619359783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 71673) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2016-09-26 |