| NPI | 1023729514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2022-12-06 |
| Last Update Date | 2022-12-06 |