| NPI | 1588057558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW112669) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2023-01-13 |