NPI | 1740640275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MS 55978) |
Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MS 160025) |
Enumeration Date | 2016-02-25 |
Last Update Date | 2018-10-17 |