| 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 |