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 |