| 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 |