| NPI | 1538465042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 109403) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2026-05-14 |