| NPI | 1386982254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00808) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-13-13506) |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2013-07-25 |