| NPI | 1518752336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 36128) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 36128) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2026-09-10 |