| NPI | 1336495746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401000111) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015164) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2020-09-29 |