| NPI | 1043663529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-14-15212) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 3101) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |