NPI | 1538622790 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-19-35156) |
225C00000X Rehabilitation Counselor | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-12 |
Last Update Date | 2023-07-11 |