| NPI | 1275194227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSB94024757) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB94024757) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2019-10-30 |