| NPI | 1881958148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60332197) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-12-12081) |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TS0200X Psychologist, School (Licence: WA 473295D) | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2022-07-21 |