| NPI | 1245631373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30339) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225C00000X Rehabilitation Counselor | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2024-05-15 |