| NPI | 1770904088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-13-13521) |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA 2967) |
| 103TS0200X Psychologist School (Licence: 2967) | |
| Enumeration Date | 2014-01-05 |
| Last Update Date | 2024-08-29 |