| NPI | 1376821728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28439) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist (Licence: CA PSY28439) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2017-08-24 |