| NPI | 1578683819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA F1306220314) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSB94025462) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2022-07-14 |