| NPI | 1629613575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 217453) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1041C0700X Social Worker, Clinical (Licence: CA 217453) | |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2021-12-28 |