| NPI | 1952942385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 204742) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2025-05-20 |