| NPI | 1174065825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: IN 1578312) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2023-11-16 |