| NPI | 1366673402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 46316) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2021-10-15 |