| NPI | 1386925204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY6881) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA PSY6881) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY6881) | |
| 103TS0200X Psychologist, School (Licence: CA PSY6881) | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2011-09-06 |