| NPI | 1801954474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 1871057) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WI 1-08-4429) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2016-01-14 |