NPI | 1407104292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY30191) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-08-27 |
Last Update Date | 2020-04-15 |