| NPI | 1932369881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA LEP 1535) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA LEP 1535) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2008-06-13 |