| NPI | 1457625295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA LEP3066) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA BCBA-D 1-08-4069) |
| 103T00000X Psychologist (Licence: CA LEP 3066) | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2013-04-11 |