| NPI | 1487391017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 157434) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor (Licence: CA 20311) | |
| 103K00000X Behavior Analyst (Licence: CA 1-25-84042) | |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2025-09-29 |