| NPI | 1073091369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY32739) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2023-07-11 |