NPI | 1922525732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW113783) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83301) |
104100000X Social Worker (Licence: CA 83301) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-08-23 |
Last Update Date | 2023-04-27 |