| NPI | 1821574138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34848) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: PA RBT-18-54816) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2024-12-03 |