| NPI | 1356212641 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 164642) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2026-09-29 |