| NPI | 1962149302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MI PP0000001248210) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2026-08-11 |