| NPI | 1649160318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY34097) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-12-10168) |
| Enumeration Date | 2025-07-05 |
| Last Update Date | 2025-07-05 |