| NPI | 1366228025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 332649) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: GA 1-20-44673) |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2024-09-19 |