| NPI | 1215407572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT142537) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2023-11-15 |