| NPI | 1730827742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 159125) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2026-08-19 |