| NPI | 1679706568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy26815) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2021-03-04 |