| NPI | 1316499098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 278471) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2022-08-03 |