| NPI | 1447027628 |
|---|---|
| Former Name | JILLIAN LEIGH MALCZYNSKI |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 4437) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 4437) |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2023-12-07 |