| NPI | 1962880658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 1-18-34117) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301016687) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2018-12-28 |