| NPI | 1306655873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 61648352) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA 61648352) |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2026-06-30 |