| NPI | 1487288619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 29174) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 220233393) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2026-02-11 |