| NPI | 1063827145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 103K00000X Behavior Analyst | |
| 103TH0100X Psychologist Health Service | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2014-06-26 |