| NPI | 1740400530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA LEP) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA LEP 1817) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |