| NPI | 1538938824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 94028055) |
| Enumeration Date | 2023-12-27 |
| Last Update Date | 2024-12-13 |