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 |