| NPI | 1245682400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130627) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2023-01-10 |