| NPI | 1073961694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401000772) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2019-11-14 |