| NPI | 1730438227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA 25204) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 25204) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2012-08-30 |