| NPI | 1952957938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 135219) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 104693) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 104100000X Social Worker | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2025-11-10 |