| NPI | 1619304862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MI 6801096167) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801096167) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2022-05-05 |