| NPI | 1790573152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-04-28 |