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 |