| NPI | 1174227524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY34595) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB94027066) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-10-16 |