| NPI | 1457122301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144423) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-02-19 |