| NPI | 1366680696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY #012484 DUP) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 1-00-0220) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-23 |