| NPI | 1346133139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 8532) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: PR RBT-25-407473) |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-12-05 |