| NPI | 1790918399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY29873) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 39252) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-08-29 |
| Last Update Date | 2022-04-15 |