| NPI | 1063916658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: LA L-356) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-17-25966) |
| 103TC0700X Psychologist, Clinical (Licence: LA 1594) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2022-08-04 |