| NPI | 1508043183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: IL 1-14-0724) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TP0814X Psychologist, Psychoanalysis | |
| Enumeration Date | 2008-01-26 |
| Last Update Date | 2024-01-08 |