| NPI | 1902207624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01445) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2016-11-18 |