| NPI | 1710875901 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 133436) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 133436) |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2025-10-17 |