| NPI | 1609336874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 150910) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-04-01 |