| NPI | 1760969828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT4983) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-07-22 |
| Last Update Date | 2024-08-06 |