| NPI | 1063234789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.08911) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OH COBA.01654) |
| Enumeration Date | 2024-10-25 |
| Last Update Date | 2026-01-20 |