| NPI | 1811216344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 28442) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-04-1841) |
| 101YP2500X Counselor, Professional (Licence: CA LPC 312) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2016-07-09 |