| NPI | 1790200806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60805415) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA BA60804346) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2020-08-06 |