| NPI | 1033468483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112746) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2021-12-30 |