| NPI | 1316464480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007897) |
| Additional Taxonomies | 103T00000X Psychologist |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2023-11-20 |