| NPI | 1679682314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 19049) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-10-18 |