| NPI | 1992074934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4297) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 4297) | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2020-12-14 |