| NPI | 1063061661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 34247) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2023-07-06 |