| NPI | 1710394747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 86038) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA D5762307) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2023-03-08 |