| NPI | 1699024745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301015191) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI 1-16-22081) |
| 101YP2500X Counselor, Professional (Licence: MI 6401013191) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2017-01-09 |