| NPI | 1962122127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 170012552) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 170012552) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2022-09-01 |