| NPI | 1164864914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY5115) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-02-09-40) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |