| NPI | 1679716229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 081039000) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSB 34205) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2009-04-13 |