| NPI | 1154284032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NC 1303716) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 250260477) |
| Enumeration Date | 2025-12-08 |
| Last Update Date | 2025-12-08 |