| NPI | 1023729944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-25-80165) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 2513140150) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2025-09-26 |