| NPI | 1306852330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist | |
| 106H00000X Marriage & Family Therapist (Licence: FL MT 2491) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-09-30 |