| NPI | 1861766958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 23924) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-00-0252) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |