| NPI | 1740834118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 92731) |
| 104100000X Social Worker (Licence: CA 92731) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 92731) | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2020-07-07 |