| NPI | 1275830721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA ASW73994) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW29204) |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW29204) | |
| 225400000X Rehabilitation Practitioner (Licence: CA ASW29204) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2018-03-17 |