| NPI | 1790241867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361008192) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: IL RBT-19-78419) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2025-07-24 |