| NPI | 1154926954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW133532) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2025-11-21 |