| NPI | 1346654282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 3487) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-11-8934) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2015-05-07 |