| NPI | 1699104240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 1492) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103T00000X Psychologist (Licence: NC 1492) | |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2015-08-21 |