NPI | 1588033963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY31842) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA D7089504) |
Enumeration Date | 2015-09-16 |
Last Update Date | 2020-09-08 |