| NPI | 1104299734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA 3635) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 3635) | |
| 103TS0200X Psychologist, School (Licence: CA LEP3635) | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2024-06-22 |