| NPI | 1841530102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 124586) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2024-07-30 |