| NPI | 1316828932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 4587) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 230054283) |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2025-09-10 |