| NPI | 1063583805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: 00004789) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY 15724) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |