| NPI | 1346709995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT154471) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 6107) |
| 101YP2500X Counselor, Professional (Licence: CA APCC19081) | |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2026-08-21 |