| NPI | 1083251987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-21-53131) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2025-01-15 |