| NPI | 1871805838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103K00000X Behavior Analyst | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2010-07-07 |