| NPI | 1295744142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-00-0058) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 7304) |
| 103T00000X Psychologist (Licence: NE 575) | |
| 103T00000X Psychologist (Licence: CO 2277) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: 1-00-0058) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-10-27 |