| NPI | 1295251056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11154) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 3927) |
| 103T00000X Psychologist (Licence: ME PS1836) | |
| 103T00000X Psychologist (Licence: NY 023447) | |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2023-05-05 |