| NPI | 1225357353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA IMF62396) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CADAC#A4001407) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2015-07-10 |