| NPI | 1518240480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: LA 1574) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: LA L-384) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2024-07-16 |