| NPI | 1629714597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6362009961) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2024-07-11 |