| NPI | 1609715911 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 250160194) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 20186) |
| Enumeration Date | 2026-03-25 |
| Last Update Date | 2026-03-25 |