| NPI | 1063916658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: LA 1594) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-17-25966) |
| 103K00000X Behavior Analyst (Licence: LA L-356) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-09-17 |