| NPI | 1326518853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 20127) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2025-09-22 |