| NPI | 1134570542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 131513) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CiCA01330619) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2022-04-15 |