| NPI | 1568780732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 856) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-10-7098) |
| 103T00000X Psychologist (Licence: NY 21219) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2023-06-28 |