| NPI | 1396867925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 62858) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2016-04-11 |