| NPI | 1043717416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT130550) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2022-10-10 |