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 |