| NPI | 1922596006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6362009457) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2022-07-19 |