| NPI | 1578029989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA 133039) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 104100000X Social Worker (Licence: CA 133039) | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2026-07-15 |