| NPI | 1255229514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 141671) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2026-09-08 |