| NPI | 1912026642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY31929) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-18-31459) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2025-10-16 |