NPI | 1740595768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27058) |
Additional Taxonomies | 101Y00000X Counselor |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2010-08-13 |
Last Update Date | 2020-07-22 |