| NPI | 1881229904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ACSW93178) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ACSW93178) |
| 104100000X Social Worker (Licence: CA ACSW93178) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA ACSW93178) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2021-04-30 |