| NPI | 1083734503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 15991) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2025-09-11 |