| NPI | 1396307393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 5997) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2022-08-15 |