| NPI | 1508441213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV MI4499) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2025-04-23 |