| NPI | 1710434279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 90005) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 90005) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 108134) | |
| 1041S0200X Social Worker, School | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-01-05 |