| NPI | 1922515501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 111183) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 111183) |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2023-07-28 |