| NPI | 1558071233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 10074703-2501) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: UT 10074703-2506) |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2023-03-09 |