| NPI | 1710605076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 00000) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-10-11 |