NPI | 1235503533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA IMF93907) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 154141-IV) |
106H00000X Marriage & Family Therapist (Licence: CA lmft104710) | |
Enumeration Date | 2015-11-24 |
Last Update Date | 2021-03-19 |