| NPI | 1447746599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 002111) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CT 000296) |
| 103K00000X Behavior Analyst (Licence: MA 1768) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2023-05-22 |