| NPI | 1053147694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 161660) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 21997) |
| 171M00000X Case Manager/Care Coordinator | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2026-04-01 |