NPI | 1477168649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35743) |
Additional Taxonomies | 103T00000X Psychologist |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-09-14 |
Last Update Date | 2025-04-08 |