| NPI | 1174182901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: DC LMFT000273) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MD LCM899) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2026-05-27 |