NPI | 1114068459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW70121) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW25044) |
225400000X Rehabilitation Practitioner | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2007-02-09 |
Last Update Date | 2018-01-03 |