NPI | 1700450178 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9443) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2021-05-19 |
Last Update Date | 2024-11-22 |