| NPI | 1396265567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA Unlicensed) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 104248) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-01-28 |