| NPI | 1023832375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-T-000071) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 94028875) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 94028875) | |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2026-05-01 |