| NPI | 1649793431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851107266) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2024-12-11 |