| NPI | 1316063415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB29748) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-09-20 |