| NPI | 1194337352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA 1669992053) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2025-12-12 |