| NPI | 1497872642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 77172) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2022-07-21 |