| NPI | 1609998335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 128398) |
| Additional Taxonomies | 103T00000X Psychologist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2022-03-29 |