| NPI | 1154685907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: CA PSB 94022610) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103T00000X Psychologist (Licence: CA PSB94022610) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2016-08-10 |