| NPI | 1003059387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 52882) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A5630611) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2013-03-08 |