| NPI | 1649005059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 138019) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2026-04-09 |