| NPI | 1245720366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136318) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2022-12-28 |