| NPI | 1790228302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801079188) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: MI 6801079188) |
| 106S00000X Behavior Technician (Licence: MI 6801079188) | |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2016-11-30 |