| NPI | 1053020065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AL 2289) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AL 2018-003) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 023148) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: ME PS2448) | |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2022-11-17 |