NPI | 1306219555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 115427) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
106H00000X Marriage & Family Therapist (Licence: CA 89640) | |
Enumeration Date | 2015-11-10 |
Last Update Date | 2021-11-11 |