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 |