| NPI | 1326685330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2023-10-26 |