| NPI | 1336634732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 11320502-3902) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2024-09-02 |