| NPI | 1780980771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 102690) |
| Additional Taxonomies | 104100000X Social Worker |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2023-06-21 |