NPI | 1669678835 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy24532) |
Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-15-18160) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 25432) | |
Enumeration Date | 2007-06-25 |
Last Update Date | 2018-03-17 |