| NPI | 1710320049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 002549) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2023-05-18 |