| NPI | 1568611812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 27085) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2015-03-18 |