| NPI | 1053809293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401000355) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: MI 00213530) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2020-08-10 |