| NPI | 1780813717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 66631) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 29861) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2021-10-19 |