| NPI | 1225144587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 32280) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TX 1-12-10361) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2014-05-28 |