| NPI | 1639834732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA LEP4149) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA LEP4149) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2021-11-03 |