| NPI | 1649791344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-17-26086) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT106753) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2026-01-15 |