| NPI | 1053885236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A209898) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2026-07-23 |