| NPI | 1821710278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 162710) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2026-04-09 |