| NPI | 1023691854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 122657) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 122657) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2025-02-03 |