| NPI | 1174533806 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS006978L) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA #1-07-3652) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2013-05-17 |