| NPI | 1902353964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 95680) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 77934) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2022-10-13 |