| NPI | 1104350792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW118202) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW97971) |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2023-09-22 |