| NPI | 1215482484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 32853) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2021-09-27 |