| NPI | 1962634840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 68533) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 68533) | |
| 104100000X Social Worker (Licence: CA 68533) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2024-08-08 |