| NPI | 1063747764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017761) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA 1-06-3160) |
| 103TC0700X Psychologist, Clinical (Licence: DE B1-0001038) | |
| 103TC0700X Psychologist, Clinical (Licence: NJ 35100664700) | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2022-05-24 |