| NPI | 1316215528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA LEP3168) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA LEP3168) |
| 101YS0200X Counselor, School (Licence: CA LEP3168) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2019-08-14 |