| NPI | 1346420809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: TN 1-04-1533) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TN 00010) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2020-10-29 |