| NPI | 1710394747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 136422) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 104100000X Social Worker (Licence: CA 136422) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2026-01-16 |