| NPI | 1033759618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSB94026260) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSB94026260) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2023-04-27 |