| NPI | 1053942813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 240187688) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2025-08-08 |