| NPI | 1326390410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA AP7950) |
| Additional Taxonomies | 103T00000X Psychologist |
| 171M00000X Case Manager/Care Coordinator | |
| 101YP2500X Counselor, Professional | |
| 101YM0800X Counselor, Mental Health (Licence: CA AP7950) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2024-01-23 |