| NPI | 1407396187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451019344) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI F620465744062) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2023-01-10 |