| NPI | 1619366812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW93645) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW70473) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2020-04-29 |