| NPI | 1356393235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-940) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: HI PSY-940) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-05-24 |