| NPI | 1972143949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 150517) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2024-10-11 |