| NPI | 1992173553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT 80923) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-14-17229) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2015-09-11 |