| NPI | 1578997615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P1531) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TN 1-17-26623) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2019-01-23 |