NPI | 1164197166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-21-176759) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-08-11 |
Last Update Date | 2024-07-01 |