| NPI | 1992935019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 7870) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-04-1774) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2026-03-10 |