| NPI | 1629616396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS1522) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-12-12645) |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2019-12-12 |