| NPI | 1063037463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: ND 000424851) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: ND L94) |
| 174400000X Specialist | |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2025-01-13 |