| NPI | 1730561341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY32855) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PSB94024938) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2024-02-08 |