| NPI | 1457170342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 8738) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL RBT-25-475553) |
| Enumeration Date | 2024-10-08 |
| Last Update Date | 2026-02-18 |