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 |