| NPI | 1518215508 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29241) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 103T00000X Psychologist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-22 | 
| Last Update Date | 2025-03-17 |