| NPI | 1962420349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 2003-01254) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-12-06 |