| NPI | 1578962890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0004274) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2016-01-08 |