| NPI | 1205415072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 142355) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-09-20 |