| NPI | 1073023669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101Y00000X Counselor |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2017-10-09 |