| NPI | 1255811592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5437) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-18-29731) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2019-04-05 |