| NPI | 1508116518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0000X Psychologist, Family |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSB37425) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2015-10-27 |