| NPI | 1437268125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY001980) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-03-1376) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-11-18 |