| NPI | 1649334244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2011-09-20 |