| NPI | 1841763422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-18-73414) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-01-29 |