| NPI | 1265289664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 139170) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2026-09-21 |