NPI | 1275029357 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 119421173902) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2018-07-02 |
Last Update Date | 2024-07-24 |