| NPI | 1164666558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361003361) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI 1073504) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2023-06-22 |