| NPI | 1780291633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110090) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2024-03-06 |