| NPI | 1659847929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 028388) |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103T00000X Psychologist (Licence: NJ 35SI00816900) | |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2026-09-27 |