| NPI | 1649794116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ BEH-000768) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-15945) |
| 106H00000X Marriage & Family Therapist (Licence: CA 131725) | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2023-12-06 |