| NPI | 1487334512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 159671) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA R1511440623) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2025-11-20 |