| NPI | 1447786413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101069) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW77220) |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-03-12 |