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 |