| NPI | 1174419485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW131616) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-07-10 |