| NPI | 1871642058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW75376) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA ASW 29730) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-04-26 |