| NPI | 1497390736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: CA 250115374) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2025-07-30 |