| NPI | 1922618271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA ASW103836) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA ASW103836) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2024-09-04 |