| NPI | 1639308117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27239) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2015-05-26 |