| NPI | 1861688269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 24300) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY24300) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA psb33057) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2019-08-09 |