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 |