| NPI | 1619682630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 106H00000X Marriage & Family Therapist (Licence: CA AMFT159047) | |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2026-03-09 |