NPI | 1770792459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psb32421) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB 32421) |
Enumeration Date | 2007-05-21 |
Last Update Date | 2022-01-03 |