| 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 |