| NPI | 1629461314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33549) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103T00000X Psychologist (Licence: CA PSY33549) | |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2023-03-26 |