| NPI | 1205500154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 120243) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2024-02-01 |