| 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 |