| NPI | 1912131251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NE 10133) |
| 103K00000X Behavior Analyst (Licence: NE 488) | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2022-03-16 |