| NPI | 1184154767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106S00000X Behavior Technician (Licence: CA RBT-18-65352) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2020-03-10 |