| NPI | 1891246484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 74862) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2025-07-29 |