| NPI | 1013048644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 29668) |
| 104100000X Social Worker | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2023-10-17 |