| NPI | 1538401674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 8556) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-11-7947) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2013-03-26 |