| NPI | 1427548924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 143163) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2025-08-28 |