| 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 |