| NPI | 1700068418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-05-2144) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TF0000X Psychologist Family | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2017-01-18 |