| NPI | 1356015671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MO 1-19-34559) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2021012094) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2023-01-12 |