| NPI | 1386660892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401000436) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6301008428) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2021-08-18 |