| NPI | 1003428558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 34833) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94025373) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSB94025373) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2024-04-09 |