| NPI | 1669155693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2024-12-11 |