| NPI | 1982134664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6362009232) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2021-01-07 |