| NPI | 1770617490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 1492) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225400000X Rehabilitation Practitioner (Licence: CA IMF49880) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2019-04-04 |