| NPI | 1629380704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY PSYLIP00223820) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY ABALBA00214893) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2016-04-01 |