| NPI | 1841677507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-12-10163) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: CA LEP3554) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2015-05-01 |