| NPI | 1851991798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 190155760) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-29 |