| NPI | 1063542173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 0099) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY KY-0035) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2016-05-02 |