| NPI | 1538712039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 145404) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 15959) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1353570719) | |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2024-03-03 |