| NPI | 1760931406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 121722) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 84420) |
| 1041C0700X Social Worker Clinical | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2024-05-06 |