| NPI | 1265619621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1696) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NC 1696) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 1696) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2015-11-16 |