NPI | 1174918361 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1829) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA PSB35886) |
103K00000X Behavior Analyst | |
103TC0700X Psychologist, Clinical (Licence: CA PSB35886) | |
Enumeration Date | 2015-04-03 |
Last Update Date | 2020-01-02 |