| NPI | 1730660853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 3212) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 87423) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2018-08-27 |