| NPI | 1477886455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT # 77996) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF 67571) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2014-01-07 |