| NPI | 1073392668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 153426) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 18831) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2025-04-09 |