| NPI | 1710523238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT151935) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2025-09-09 |