| NPI | 1477018513 |
|---|---|
| Former Name | DUSTIN EVANS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851114609) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-02-03 |
| Last Update Date | 2024-09-25 |