| NPI | 1972895076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 25873) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-08-4806) |
| Enumeration Date | 2011-05-07 |
| Last Update Date | 2015-05-20 |