| NPI | 1891239778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW91638) | |
| 247200000X Technician, Other (Licence: CA RBT-16-20865) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2023-10-03 |