| NPI | 1659862225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 109814) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 90602) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-19 |
| Last Update Date | 2022-08-24 |