| NPI | 1811410269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 127665) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61647262) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical (Licence: AZ 23645) | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2026-03-05 |