| NPI | 1780238030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 5807) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NC 1-19-35125) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2023-09-11 |