| NPI | 1053492397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019270) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-05-2534) |
| 103K00000X Behavior Analyst (Licence: GA 1-05-2534) | |
| 103T00000X Psychologist (Licence: ME PSY 1234) | |
| 103K00000X Behavior Analyst (Licence: ME 1-05-2534) | |
| 103T00000X Psychologist (Licence: FL PY8664) | |
| 103T00000X Psychologist (Licence: NE 760) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2023-10-11 |