| NPI | 1811726110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-2210) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-10-11 |