| NPI | 1346796414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY34205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA d1204909) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2023-10-11 |