| NPI | 1104342369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: FL 8789) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-04-1777) |
| Enumeration Date | 2017-08-19 |
| Last Update Date | 2023-03-04 |