| NPI | 1821817230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA ASW127149) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2024-10-03 |
| Last Update Date | 2024-11-07 |