| NPI | 1386420503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-09-04 |