| NPI | 1003317306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106S00000X Behavior Technician | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2023-09-12 |