| 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 |