| NPI | 1184133654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401002914) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2026-03-06 |