| NPI | 1770028839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008114) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2023-04-04 |