| NPI | 1831648310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 95000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 104100000X Social Worker (Licence: CA ASW77423) | |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2021-05-27 |