| NPI | 1871073239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33315) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2022-05-06 |