| NPI | 1811147713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY28761) | |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2017-01-20 |