| NPI | 1982276754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 128713) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 102653) |
| 1041C0700X Social Worker, Clinical (Licence: CA 102653) | |
| 1041C0700X Social Worker, Clinical | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2025-07-28 |