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 |