| NPI | 1730434275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-08-4190) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 48133) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2020-05-11 |