| NPI | 1912248790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4848) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: PA PS008536L) | |
| 103TC0700X Psychologist Clinical (Licence: NC 4848) | |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2015-10-01 |