| NPI | 1184865354 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 0824) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NC 0824) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 0824) | |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2009-03-17 |