| 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 |