| NPI | 1235896044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33771) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 94026294) |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2023-07-17 |