| NPI | 1770976615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 94603) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-16-22983) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2021-07-22 |