| NPI | 1649632670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 12108) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2023-08-28 |