| NPI | 1205009768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 49505) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 104550) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2016-11-30 |