| NPI | 1821584301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 120120) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA APCC5100) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2018-07-08 |
| Last Update Date | 2024-05-24 |