| NPI | 1720431059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 103K00000X Behavior Analyst | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2019-08-13 |