| NPI | 1316284425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY35199) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-08-4302) |
| 103TS0200X Psychologist, School (Licence: CA LEP 2868) | |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2024-08-28 |