| NPI | 1417432881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401002449) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6362009871) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2025-04-14 |