NPI | 1679334932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA LEP4408) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LEP4408) |
Enumeration Date | 2024-01-23 |
Last Update Date | 2024-01-23 |