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 |