| NPI | 1750949285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 148342) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2025-07-06 |