| NPI | 1134699630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YM0800X Counselor, Mental Health (Licence: CA 130516) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2023-10-10 |