| NPI | 1154636660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 018710) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 1052171) |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2010-08-10 |