| NPI | 1063547628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1162) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KS 131) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2023-10-30 |