| NPI | 1306239256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 147564) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: CA 118405) | |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2024-06-24 |