| NPI | 1700433810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35712) |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2025-03-02 |