| NPI | 1609239821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI Psy-2208-0) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-10-21 |