| NPI | 1003246364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 31181) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 31181) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2019-11-24 |