| NPI | 1962635045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 26328) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 225C00000X Rehabilitation Counselor | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2020-12-21 |