| NPI | 1427462357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 94024044) |
| Additional Taxonomies | 101Y00000X Counselor |
| 225C00000X Rehabilitation Counselor (Licence: CA 94024044) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2023-06-12 |