| NPI | 1851621577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301017218) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2020-06-11 |