| NPI | 1659651370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 84796) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 62012) |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2020-08-11 |