| 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 |