| NPI | 1902203888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 95473) |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical (Licence: CA ACSW95473) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2025-08-18 |