| NPI | 1154558922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 22047) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-18-32859) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2019-01-07 |