| NPI | 1578168175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 165232) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2026-10-09 |