| NPI | 1407256746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 605) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 605) |
| 103G00000X Clinical Neuropsychologist (Licence: OR 605) | |
| 103K00000X Behavior Analyst (Licence: OR 605) | |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2020-09-16 |