| NPI | 1902110729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 98093) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 98093) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2020-12-21 |