| NPI | 1093403339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA ASW131941) |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2025-07-23 |