| NPI | 1679084859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851116602) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2023-05-31 |