| NPI | 1184132615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2025-05-16 |