| NPI | 1679130579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 205690) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-05-26 |
| Last Update Date | 2024-11-12 |