| NPI | 1568050235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2025-06-27 |