| NPI | 1497397178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 117467) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 117467) | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA 117467) | |
| 225C00000X Rehabilitation Counselor (Licence: CA 117467) | |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2024-06-19 |