| NPI | 1821778770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 4374) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 104053) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-07-24 |