| NPI | 1013500529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401002305) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician | |
| 156F00000X Technician/Technologist | |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2024-01-09 |