| NPI | 1851874325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 34071) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 0005992) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2023-03-13 |