| NPI | 1528375847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33834) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103G00000X Clinical Neuropsychologist (Licence: CA 33834) | |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2023-01-18 |