| NPI | 1548518772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-15-18747) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801094670) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2017-03-09 |