| NPI | 1750888665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 147561) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2024-11-15 |