| NPI | 1629327242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW79248) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW62465) |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2019-07-18 |