| NPI | 1437886751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 111190) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2022-10-27 |