| NPI | 1699226969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: CO MFT.0001279) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA 000846) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2018-11-08 |