| NPI | 1073197844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 110790) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2024-11-01 |