| NPI | 1104993153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 823057) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WI 54-140) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2015-11-17 |