| 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 |