| NPI | 1982026613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW104671) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW78635) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2023-12-22 |