| NPI | 1942733654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 140004493) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 872656) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |