| NPI | 1245664036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 10663-R) |
| 106H00000X Marriage & Family Therapist (Licence: CA 70219) | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2018-05-18 |