| NPI | 1356344469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040970A) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY 101602) |
| 103K00000X Behavior Analyst (Licence: OH COBA.122) | |
| 103T00000X Psychologist (Licence: KY 128036) | |
| 103T00000X Psychologist (Licence: KY 0834) | |
| 103TC0700X Psychologist, Clinical (Licence: KY 128036) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2017-11-22 |