| NPI | 1386138584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KY 266046) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY 261022) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-01-18 |