| 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 |