| NPI | 1811398050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 12310) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-09-6369) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2014-09-08 |