| NPI | 1093049199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 0537) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 0537) |
| 103K00000X Behavior Analyst (Licence: NC 0537) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 537) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 0537) | |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2009-12-17 |