| NPI | 1205114550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 28915) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 28915) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2024-09-17 |