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 |