| 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 |