| NPI | 1396473518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2022-08-15 |