| NPI | 1982070967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP2701X Psychologist Group Psychotherapy (Licence: DE 463089081) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: DE 463089081) |
| 171M00000X Case Manager/Care Coordinator (Licence: DE 463089081) | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-08-13 |