| NPI | 1023232717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R124030916) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA Prelicensed#IMF50522) |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF70529) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2019-03-12 |