| NPI | 1891430245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 34428) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2022-04-30 |
| Last Update Date | 2024-07-01 |