| NPI | 1073876603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801020222) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI 1073475) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301006322) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2020-07-14 |