| NPI | 1144836925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144120) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2024-03-25 |