| NPI | 1598089492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 25972) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-09-6462) |
| Enumeration Date | 2010-03-21 |
| Last Update Date | 2013-11-01 |