| NPI | 1225697279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2023-10-04 |