| NPI | 1396196085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2016027813) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2026-02-24 |