NPI | 1932621034 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35056) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA 35056) |
103TC0700X Psychologist, Clinical (Licence: CO PSY.0006386) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-07-10 |
Last Update Date | 2024-05-29 |