| NPI | 1255019337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT165291) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YM0800X Counselor, Mental Health (Licence: CA APCC23746) | |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2026-10-01 |