| NPI | 1376274308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW131736) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2025-07-15 |