| NPI | 1255670741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361000506) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI 7401000423) |
| 103T00000X Psychologist (Licence: MI 6361000506) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6361000506) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6361000506) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2024-07-03 |