| NPI | 1659674786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 023165-01) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-11-8810) |
| Enumeration Date | 2010-12-12 |
| Last Update Date | 2022-04-06 |