| NPI | 1821697178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 116212) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2025-12-05 |