| NPI | 1821610650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist |
| 106E00000X Assistant Behavior Analyst | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2023-08-02 |