| NPI | 1861053548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6362009517) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6361008184) |
| 156F00000X Technician/Technologist | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-10-29 |