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 |