NPI | 1073197844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW110790) |
Additional Taxonomies | 175T00000X Peer Specialist |
225400000X Rehabilitation Practitioner | |
1041C0700X Social Worker, Clinical (Licence: CA 110790) | |
Enumeration Date | 2021-05-07 |
Last Update Date | 2024-11-21 |