| NPI | 1811543515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 154524) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 137901) |
| 106S00000X Behavior Technician | |
| 106H00000X Marriage & Family Therapist (Licence: CA 137901) | |
| Enumeration Date | 2019-08-18 |
| Last Update Date | 2026-08-30 |