| NPI | 1538468392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 7985) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 1-05-2212) |
| Enumeration Date | 2011-03-19 |
| Last Update Date | 2011-03-19 |