| NPI | 1184261869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8448) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-04-1706) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2022-03-28 |