| NPI | 1538617634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI S610465373288) |
| Enumeration Date | 2016-09-17 |
| Last Update Date | 2024-12-17 |