| 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 |