| NPI | 1124336953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW99038) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2025-02-23 |