| NPI | 1952668949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 01-07-3648) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2025-07-25 |