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 |