| NPI | 1396085114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA D6531652) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2026-09-16 |