| NPI | 1821594649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301017805) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI 18-52198) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2019-11-14 |