| NPI | 1992732515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WV 532) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS004475L) |
| 103K00000X Behavior Analyst (Licence: WV 532) | |
| 103K00000X Behavior Analyst (Licence: PA PS004475L) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: WV 532) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS004475L) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WV 532) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS004475L) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: WV 532) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: PA PS004475L) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2015-10-07 |