NPI | 1023464864 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA IMF90645) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Rii2880115) |
Enumeration Date | 2016-05-11 |
Last Update Date | 2016-05-11 |