| 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 |