| NPI | 1023396462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT110888) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii4781214) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2019-02-28 |