NPI | 1316330459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 13311) |
Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-12-11590) |
Enumeration Date | 2015-03-13 |
Last Update Date | 2015-03-13 |