| NPI | 1922845270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0006420) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CO 1-22-60816) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2024-07-12 |