| NPI | 1225518343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 117516) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2023-08-22 |