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