| NPI | 1104711233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 132497) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-08-05 |