| NPI | 1407137466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW74251) |
| Additional Taxonomies | 104100000X Social Worker |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2022-11-30 |