| NPI | 1730685298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11777) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-19-37688) |
| 103K00000X Behavior Analyst (Licence: MA 3496) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2022-04-21 |