| NPI | 1144513755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 99017) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA IMF75094) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF75094) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2017-08-01 |