| NPI | 1407108566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 013879-1) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 1-00-0171) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2012-10-12 |