| NPI | 1821749060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106S00000X Behavior Technician | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2026-04-09 |