| NPI | 1871900373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401000465) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301011549) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6361004249) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2021-10-12 |