NPI | 1700226289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: CA PSY28114) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA 28114) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-06-28 |
Last Update Date | 2023-12-06 |