| NPI | 1194641464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 260075400) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CT 4869157040) |
| 103TS0200X Psychologist, School (Licence: IL 2702085) | |
| Enumeration Date | 2026-06-29 |
| Last Update Date | 2026-06-29 |