| NPI | 1518262757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 11416056) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMFT70391) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2015-06-05 |