| NPI | 1891068060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA MHRS) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| 225400000X Rehabilitation Practitioner (Licence: CA 225400000X) | |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2025-05-26 |