| NPI | 1043798325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 119616) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-57721) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2020-10-02 |