| NPI | 1083849897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105118) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 105118) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 111973) | |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2018-09-03 |