| NPI | 1053697904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA mfc30490) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA bcba# 1-10-7653) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-10-24 |