| NPI | 1023691854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122657) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2024-05-22 |