| NPI | 1578901559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301008035) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WV 673) |
| 103K00000X Behavior Analyst (Licence: FL Fl Exempt 490.014) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2014-01-31 |