| NPI | 1598070476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401001819) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2022-12-12 |