| NPI | 1245800705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851109642) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801109642) | |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2022-12-21 |