| NPI | 1629379987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99029) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 63539) |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2021-01-11 |