| NPI | 1750540852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 98721) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 98721) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101Y00000X Counselor (Licence: CA 98721) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2023-09-15 |