| NPI | 1063525079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1839-057) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WI 11-140) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2015-11-17 |