| NPI | 1801268750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04211) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MD LBA084) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2015-10-30 |