| NPI | 1417097866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TN 0000001775) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TN 0000001775) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-10-03 |