| NPI | 1285211011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CA PSB94025624) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB94025624) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2023-07-10 |