| NPI | 1306630256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 142570) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2026-09-24 |