| NPI | 1043910789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TF0000X Psychologist Family | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-09 |