| NPI | 1821548546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 104540) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW84470) |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker (Licence: CA LCSW104540) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2024-01-03 |