| NPI | 1801097167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: AZ 3804461) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 060034330) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2007-07-08 |