| NPI | 1083192504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA 94029371) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2025-11-06 |