| NPI | 1750926770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: CA RBT-25-492418) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT160696) |
| 101YP2500X Counselor, Professional (Licence: CA APCC21135) | |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2026-06-23 |