| NPI | 1194276949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA PSB94026166) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2023-07-28 |