| NPI | 1821547316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-47121) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2022-04-21 |