| NPI | 1063908150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT4599) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-22-59812) |
| 251S00000X | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2023-06-13 |